Insurer Sees Success with Patient-Centered Medical Home Program

The patient-centered medical home (PCMH) has been described as a model of "whole person" care delivery, 1 that is designed to support the goals of the Triple Aim. With team collaboration, the PCMH enhances patient access as well as their continuity of care. Now, 1 insurer reports that 1.1 million people who received care through its PCMH in 2013 were not only hospitalized less often, but they reported shorter lengths of stay than patients in fee-for-service care.

Published Online: July 10, 2014

Katie Sullivan, MA

The patient-centered medical home (PCMH) has been described as a model of “whole person” care delivery, 1 that is designed to support the goals of the Triple Aim. With team collaboration, the PCMH enhances patient access as well as their continuity of care. Now, 1 insurer reports that 1.1 million people who received care through its PCMH in 2013 were not only hospitalized less often, but they reported shorter lengths of stay than patients in fee-for-service care.

CareFirst BlueCross BlueShield, an insurer based in Washington, DC, explained that the program — now in its 4th year — saved the organization $130 million (3.5%) in spending when compared to traditional fee-for-service operations. Providers were reimbursed 12% more than the standard rate for participating in the medical home program, and up to 36% more based on the quality of care they provided. All said, a practitioner could have earned nearly $50 more for a procedure usually reimbursed at $100.

“I tell physicians, ‘You’re going to get paid extra to handle your sickest patients,’” said Kevin Schendel , MD, an internist who participated in the CareFirst program. He continued saying: “The financial rewards that the physician gets in my opinion are secondary. The real reward is that patient who gets to work with that nurse and it doesn’t cost my practice a penny. And they get better care. There’s the reward.”

He also noted that the PCMH helped many of his patients avoid unnecessary visits to the emergency department.

According to an official release from CareFirst, for every 1,000 CareFirst members 6.4% had fewer hospital admissions, just over 11% spent fewer days in the hospital, 8.1% had fewer hospital all-cause readmissions, and 11.3% had fewer outpatient health facility visits.

“Increasingly, the data we are seeing on quality and cost for the physicians participating in our PCMH program and our members under their care give us confidence that our program is taking hold and headed in the right direction,” said CareFirst President and CEO Chet Burrell. “With this said, given national trends downward over the last few years, it would be unfair to attribute these shifts solely to our program, but we believe the PCMH program has had a significant contributory effect.”